Sunday, March 12, 2017

Recent Hepatitis C Virus Testing Patterns Among Baby Boomers

Introduction
Approximately 3.5 million people are chronically infected with hepatitis C virus (HCV) in the U.S., 80% of whom are “baby boomers” (born between 1945 and 1965).1 Most infected individuals are not aware of their infections despite availability of treatments that may reduce their risk of HCV-related diseases, including chronic hepatitis, cirrhosis, and liver cancer.2 To curb the growing burden of these HCV-associated diseases, the U.S. Preventive Services Task Force (USPSTF) recommended one-time HCV testing for baby boomers in 2013.3 The authors previously noted low HCV testing prevalence among baby boomers in 2013, at baseline4; however, it is unknown whether HCV testing has changed following the USPSTF recommendation.

Methods
Data from the 2013 and 2015 National Health Interview Survey, including 23,967 baby boomers, were used. Self-reported HCV blood testing was the primary study outcome. Analyses were restricted to respondents with non-missing HCV testing data (n=21,827). Weighted prevalence of HCV testing (ever) was calculated by sociodemographic and lifestyle factors. Multivariable prevalence ratios (PRs) and 95% CIs of HCV testing according to the 2015 survey were estimated using predicted margins. Interaction terms between survey year and each covariate were included in additional models using 2013 and 2015 survey data to determine if changes in HCV testing varied across subgroups; none were statistically significant (data not shown). All statistical analyses were conducted in 2016 with SAS-callable SUDAAN, version 9.0.3.

Results
From 2013 to 2015, HCV testing prevalence among baby boomers slightly increased from 12.3% to 13.8% (p=0.013) (Table 1). Of the 76.2 million estimated baby boomers in 2015, only 10.5 million reported ever receiving HCV testing. Relative to privately insured adults, those with Medicare plus Medicaid (PR=1.83, 95% CI=1.32, 2.53), Medicaid only (PR=1.35, 95% CI=1.04, 1.76), or military insurance (PR=1.62, 95% CI=1.16, 2.26) had higher HCV testing prevalence. HCV testing was also greater in men versus women (PR=1.25, 95% CI=1.08, 1.44) and among people who had lived with someone with hepatitis versus those who did not (PR=2.44, 95% CI=2.01, 2.96). Individuals with less than or only a high school diploma had lower HCV testing than college graduates (PR=0.63, 95% CI=0.48, 0.82 and PR=0.58, 95% CI=0.48, 0.72, respectively).

aWeighted number receiving hepatitis C virus testing in 2013 was 9,144,299 and in 2015 was 10,511,639. Weighted number eligible for hepatitis C virus testing in 2013 was 74,506,656 and in 2015 was 76,178,472. Weighted numbers take into account the assigned sampling weights of respondents.

There was a small, albeit statistically significant, increase in HCV testing (from 12.3% to 13.8%) among baby boomers 2 years after the 2013 USPSTF recommendation for one-time HCV testing. Reasons for the overall slow uptake of testing may include barriers to preventive care; unapparent symptoms; lack of awareness of the need to be tested among patients, who may not be fully covered by insurers2; and lack of physician awareness of the USPSTF recommendations. The relatively higher prevalence of testing in military-insured individuals may reflect ongoing HCV testing in the Veterans Health Administration to reduce the disproportionately high burden of HCV-associated disease in this population.5, 6, 7

Greater HCV testing in those with dual Medicare and Medicaid and Medicaid-only insurance coverage may reflect more risk factors for HCV and associated diseases in this population.8 People with lower educational attainment and the uninsured had especially suboptimal HCV testing, despite having greater HCV burden, perhaps as a result of lower awareness about testing and barriers to accessing care.1 Limitations of this study include recall bias due to self-reported HCV testing and exclusion from the National Health Interview Survey of institutionalized baby boomers (e.g., incarcerated individuals and active-duty military) in whom HCV testing and infection may be more common.6, 7 The HCV testing estimates are substantially lower than those from recent studies among baby boomers,9, 10 where 90% of patients in a safety net clinic were tested, and in a New York community hospital where testing increased from 47% before to 88% after an intervention to improve HCV testing was put into place.9, 10 The lower proportion of HCV testing in the current study’s population could be a result of under-reporting of HCV testing, as well as differences between the current study population and these institutional-based studies.9,

Conclusions
Prevalence of HCV testing among baby boomers did not substantially increase and remains low 2 years after the USPSTF recommendation in 2013. Notably, only 10.5 million of 76.2 million baby boomers reported ever receiving HCV testing. These findings underscore the need for increased awareness for HCV testing among healthcare providers and baby boomers and other innovative strategies such as state-mandated HCV testing.http://www.ajpmonline.org/article/S0749-3797(17)30092-2/fulltext

HCV Education
Review learning activities, editorials, with new data about interferon-free regimens approved for HCV, as well as investigational drugs still in the pipeline. Links are provided to support, patient friendly information, clinical trials, peer-reviewed journals, videos, conferences with commentary, all updated on a continuous basis.

Users can search for a hepatitis C clinical trial by category (genotype), or learn how to evaluate a clinical trial and become familiar with commonly used terms. HCV Advocate offers an easy to navigate HCV Medications Blog as well, organized by HCV genotype

View each rebuttal and all ongoing media coverage. In June the HCV community was blindsided when an article with a somewhat "clickbait" headline was released by The Guardian. The Guardian reported on a systematic review published by the Cochrane Collaboration that suggested achieving SVR (cure) for patients using hepatitis C direct-acting antivirals (DAAs) doesn't correlate with any long term benefits.

The controversy over expensive new drugs for hepatitis C
Link to research and news articles addressing the high cost of hepatitis C drugs; insurance restrictions - private insurers/Medicaid - and availability of generic versions/India, Egypt and other lower-income countries or through online "buyers clubs"

Liver Cancer After Treatment For Hepatitis C
​Research demonstrates that while SVR markedly reduced liver-related complications and liver cancer, some long-term risk for liver cancer remained in those who were cured of Hepatitis C. But after direct-acting antiviral therapy does the risk of developing liver cancer increase?

Meeting Updates

April 19-23
The European Association for the Study of the Liver (EASL) International Liver Congress (ILC 2017)

Merck today announced its strategic decision to discontinue the development of the investigational combination regimens MK-3682B (grazoprevir/ruzasvir/ uprifosbuvir) and MK-3682C (ruzasvir/uprifosbuvir) for the treatment of chronic hepatitis C virus (HCV) infection. This decision was made based on a review of available Phase 2 efficacy data and in consideration of the evolving marketplace and the growing number of treatment options available for patients with chronic HCV infection

Two HCV Drugs to Be Discontinued
The Food and Drug Administration (FDA) announced that Rebetol(ribavirin; Merck) capsules and PegIntron (peginterferon alfa-2b; Merck) for Injection are being discontinued. The decision is business-related and not due to safety or efficacy issues with the drugs.

Rebetol is a nucleoside analogue indicated for chronic hepatitis C in combination with interferon alfa-2b (pegylated and nonpegylated), in patients ≥3 years of age with compensated liver disease. It is supplied as 200mg capsules in 56-, 70-, and 84-count bottles. The Rebetol discontinuation is effective February 1, 2016.
PegIntron is an antiviral indicated for treatment of chronic hepatitis C in patients with compensated liver disease. It is supplied as 50mcg/0.5mL, 80mcg/0.5mL, 120mcg/0.5mL, and 150mcg/0.5mL single-use vials and single-use pre-filled pens. No effective date is available for the PegIntron discontinuation.

If this site contains copyrighted material the use of which has not been specifically authorized by the copyright owner, it is being made available in an effort to advance the understanding of the ethics dealing with medical practice, medical care, new drug research, drug trials, science and scientific research, human rights, social justice and, in addition, the law and politics which cover these areas.

It is believed that this use constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed to visitors of this “HCV New Drugs Blog” without profit to the blog or to those who by visiting this blog have expressed interest in receiving the included information for research and educational purposes.

The material in this site is provided for educational and informational purposes only, and is not intended to be a substitute for a health care provider's consultation. Please consult your own appropriate health care provider about the applicability of any opinions or recommendations with respect to your own symptoms or medical conditions. The information on this site does not constitute legal or technical advice